The suprascapular nerve block (SScNB) is easily administered using a landmark-based technique: A cadaveric study to assess nerve staining post-injection

Abstract

Aims: The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. To widen availability of this treatment, we investigate whether an anatomical landmark technique can be adopted by novice injectors to provide efficacious blockade.

Methods: Five injectors were recruited with varying experience. 10 shoulders of Thiel embalmed cadavers were injected with blue dye. Written instructions and an illustration of the Dangoisse landmark technique were provided prior to injection. Cadavers were dissected and the presence or absence of dye staining reported by three observers and a consensus agreement reached.

Results: Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders had adequate staining of the suprascapular nerve directly, or distal branches, which would provide adequate anaesthesia. Inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k = 0.87) for staining distally. The technique was performed by novice injectors with a good success rate.

Conclusion: This technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider group of patients.

Keywords: Suprascapular nerve block; landmark technique.

Figure 1.

Set up for injection.

Figure 2.

Injection approach.

Figure 3.

Supraspinous fossa dissection.

Figure 4.

Dissection surrounding suprascapular notch.

Figure 5.

Infraspinous fossa dissection.